Risk of Late-onset Epilepsy After Myocardial Infarction and Risks of Myocardial Infarction and Cardiovascular Death After Late-onset Epilepsy Among Stroke-free Older Adults: Bidirectional Associations
Abstract number :
2.072
Submission category :
16. Epidemiology
Year :
2024
Submission ID :
1216
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Evan Thacker, PhD – Brigham Young University
Hyunmi Choi, MD, MS – Columbia University Medical Center
Kevin Strobino, MPH – Weill Cornell Medicine
Minghua Liu, PhD – Columbia University
Sylwia Misiewicz, MA, MEd – Columbia University
John Beard, PhD – Brigham Young University
Tatjana Rundek, MD, PhD – University of Miami
Mitchell Elkind, MD, MS, MPhil – Columbia University, America Heart Association
Jose Gutierrez, MD, MPH – Columbia University
Rationale: Subclinical cerebrovascular disease may cause late-onset epilepsy (LOE). Subclinical atherosclerotic vascular disease can affect multiple organs. Therefore, we hypothesize that (1) stroke-free older adults who experience incident myocardial infarction (MI) and remain stroke-free have an increased risk for subsequent incident LOE and (2) stroke-free older adults who experience incident LOE and remain stroke-free have increased risks for subsequent incident MI and non-stroke cardiovascular (CV) death.
Methods: The Northern Manhattan Study (NOMAS) is a population-based longitudinal cohort of older adults enrolled in 1993-2001. Study participants who were free of history of stroke, MI, and epilepsy at baseline were followed prospectively. Incident LOE was ascertained by participant report, hospitalization record, or appearance of International Classification of Diseases (ICD)-9 or ICD-10 codes in the New York Statewide Planning and Research Cooperative System, followed by medical record review and adjudication by a study neurologist. Incident MI and stroke were ascertained by participant report followed by an in-person study visit and adjudication by study physicians. We used Cox proportional hazards regression models with censoring at incident stroke, death, or end of follow-up to assess the associations of (1) incident MI with subsequent incident LOE, (2) incident LOE with subsequent incident MI, and (3) incident LOE with non-stroke CV death, all in the absence of stroke. We adjusted for demographics, health behaviors, and comorbid diagnoses after backward selection of variables using the delta mean squared error method.
Results: Participants were on average 69.1 ± 10.4 years of age at baseline and 63.5% were female. During a mean of 14 years of follow-up amongst 3,174 participants, 296 participants developed incident MI, 120 participants developed incident LOE, and 794 participants died of non-stroke CV causes (Table 1). Individuals with incident MI were 2.13 (95% CI: 1.06, 4.27; p = 0.033) times as likely to develop subsequent incident LOE as those without incident MI. Individuals with incident LOE were 1.99 (95% CI: 0.98, 4.06; p = 0.058) times as likely to develop subsequent incident MI and 2.86 (95% CI: 2.10, 3.89; p < 0.001) times as likely to die from non-stroke CV causes as those without incident LOE.
Epidemiology